Method for treating outflow tracts

ABSTRACT

A balloon dilation catheter includes a substantially rigid inner guide member and a movable shaft coupled to a balloon that is slidably mounted on the substantially rigid inner guide member. To treat a sinus cavity of a subject using the balloon dilation the substantially rigid inner guide member is advanced into a drainage pathway of the sinus (e.g., frontal recess) of the subject via a nasal passageway. The shaft and balloon are advanced in a distal direction over the substantially rigid inner guide member to place the balloon in the drainage pathway. The balloon is inflated to expand or otherwise remodel the drainage pathway.

RELATED APPLICATIONS

This Application is a continuation of U.S. patent application Ser. No.13/644,538, filed on Oct. 4, 2012, now U.S. Pat. No. 8,882,795, which isa continuation of U.S. patent application Ser. No. 13/116,712 filed onMay 26, 2011, which is a continuation of U.S. application Ser. No.12/479,521, filed on Jun. 5, 2009, now U.S. Pat. No. 8,282,667. Theabove-noted Applications are incorporated by reference as if set forthfully herein.

FIELD OF THE INVENTION

The field of the invention generally relates to balloon inflationdevices and methods. More particularly, the field of the inventionrelates to balloon dilation devices and methods for the treatment ofsinusitis.

BACKGROUND OF THE INVENTION

Sinusitis is a condition affecting over 35 million Americans, andsimilarly large populations in the rest of the developed world.Sinusitis occurs when one or more of the four paired sinus cavities(i.e., maxillary, ethmoid, frontal, sphenoid) becomes obstructed, orotherwise has compromised drainage. Normally the sinus cavities, each ofwhich are lined by mucosa, produce mucous which is then moved by beatingcilia from the sinus cavity out to the nasal cavity and down the throat.The combined sinuses produce approximately one liter of mucous daily, sothe effective transport of this mucous is important to sinus health.

Each sinus cavity has a drainage pathway or outflow tract opening intothe nasal passage. This drainage passageway can include an ostium, aswell as a “transition space” in the region of the ostia, such as the“frontal recess,” in the case of the frontal sinus, or an “ethmoidalinfundibulum,” in the case of the maxillary sinus. When the mucosa ofone or more of the ostia or regions near the ostia become inflamed, theegress of mucous is interrupted, setting the stage for an infectionand/or inflammation of the sinus cavity, i.e., sinusitis. Though manyinstances of sinusitis may be treatable with appropriate medicates, insome cases sinusitis persists for months or more, a condition calledchronic sinusitis, and may not respond to medical therapy. Some patientsare also prone to multiple episodes of sinusitis in a given period oftime, a condition called recurrent sinusitis.

Balloon dilation has been applied to treat constricted sinus passagewaysfor the treatment of sinusitis. These balloon dilation devices typicallyinvolve the use of an inflatable balloon located at the distal end of acatheter such as a balloon catheter. Generally, the inflatable balloonis inserted into the constricted sinus passageway in a deflated state.The balloon is then expanded to open or reduce the degree ofconstriction in the sinus passageway being treated to facilitate bettersinus drainage and ventilation. At the same time most, if not all, ofthe functional mucosal tissue lining of the sinuses and their drainagepassageways are preserved.

Exemplary devices and methods particularly suited for the dilation ofanatomic structures associated with the maxillary and anterior ethmoidsinuses are disclosed, for example, in U.S. Pat. No. 7,520,876 and U.S.Patent Application Publication No. 2008-0172033. Other systems have beendescribed for the treatment of various other sinuses including thefrontal sinus. For example, U.S. Patent Application Publication No.2008-0097295 discloses a frontal sinus guide catheter (FIG. 6B) andmethod of treating the frontal sinuses (e.g., FIGS. 8B-8C). U.S. PatentApplication Publication No. 2008-0125626 discloses another guide device(e.g., FIGS. 10C and 10C′) for transnasal access to the frontal sinusesfor treatment.

SUMMARY OF THE INVENTION

In a first embodiment of the invention, a balloon dilation catheterincludes a substantially rigid inner guide member and a movable shaftcoupled to a balloon that is slidably mounted on the substantially rigidinner guide member. To treat a drainage pathway of a sinus cavity (e.g.,frontal sinus cavity) of a subject using the balloon dilation catheter,the substantially rigid inner guide member is advanced into a drainagepathway of the subject via a nasal passageway. The shaft and balloon arethen advanced in a distal direction over the substantially rigid innerguide member to place the balloon in the drainage pathway. This enablesthe balloon to track over the inner guide member. The balloon isinflated to expand or otherwise remodel the drainage pathway. Where thesinus cavity is the frontal sinus cavity the drainage pathway is thefrontal recess.

In another aspect of the invention, a device for dilating the outflowtract of a sinus cavity includes a substantially rigid inner guidemember having a proximal end and a distal end and a shaft coupled to aballoon, the shaft having a first lumen along at least a portion thereofcontaining the substantially rigid inner guide member, the shaft havinga second lumen operatively coupled to the interior of the balloon. Ahandle is disposed along a proximal portion of the substantially rigidinner guide member, the handle including a moveable knob operativelycoupled to the shaft, wherein distal advancement of the knob advancesthe shaft and balloon over the substantially rigid inner guide in adistal direction.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 illustrates a perspective view of a balloon dilation catheteraccording to one embodiment.

FIG. 2A illustrates a side view of a balloon dilation catheter ofFIG. 1. The advancer knob is illustrated in the retracted, proximalposition.

FIG. 2B illustrates a cross-sectional view of the balloon dilationcatheter of FIG. 2A.

FIG. 3A illustrates a side view of a balloon dilation catheter ofFIG. 1. The advancer knob is illustrated in the advanced, distalposition.

FIG. 3B illustrates a cross-sectional view of the balloon dilationcatheter of FIG. 3A.

FIG. 4 is a cross-sectional view of the handle portion (dashed lineportion) of FIG. 3B.

FIG. 5A is a cross-sectional view of the balloon dilation catheter takenalong the line A-A′ of FIG. 2B.

FIG. 5B is a cross-sectional view of the balloon dilation catheter takenalong the line B-B′ of FIG. 4.

FIG. 6A is a side view of an inner guide member according to oneembodiment.

FIG. 6B is a side view of an inner guide member according to anotherembodiment.

FIG. 6C is a side view of an inner guide member according to anotherembodiment.

FIG. 7 illustrates a perspective view of a balloon dilation catheteraccording to another embodiment.

FIG. 8 illustrates a cross-sectional view of the frontal sinus of asubject with the inner guide member of the balloon dilation catheterbeing advanced into the subject's frontal recess.

FIG. 9 illustrates a cross-sectional view of the frontal sinus of asubject with the inner guide member of the balloon dilation catheterbeing positioned in the subject's frontal recess. A guide wire is shownadvanced through the catheter and into the subject's frontal sinuscavity.

FIG. 10 illustrates a cross-sectional view of the frontal sinus of asubject with the balloon (in a deflated state) and shaft being advancedinto the subject's frontal recess.

FIG. 11 illustrates a cross-sectional view of the frontal sinus of asubject with the balloon of FIG. 10 in an inflated state to therebywiden and remodel the frontal recess.

FIG. 12 illustrates a cross-sectional view of the frontal sinus of asubject after the frontal sinus has been widened and the ballooninflation catheter withdrawn.

DETAILED DESCRIPTION OF THE ILLUSTRATED EMBODIMENTS

FIG. 1 illustrates one embodiment of a balloon dilation catheter 10 thatis particularly suited for treatment of the outflow tract (frontal sinusostium and frontal recess) of the frontal sinus of a subject. Theballoon dilation catheter 10 includes a handle 12 that is configured tobe gripped or otherwise manipulated by the operator. An elongate-shapedinner guide member 14 extends longitudinally from the handle 12 in adistal direction. The inner guide member 14 is formed of a suitablyrigid material such as stainless steel hypotube. The inner guide member14 projects or otherwise extends distally from the handle 12 for apre-determined distance. The inner guide member 14 may be pre-shaped tohave a curved distal portion 16 as is illustrated in FIGS. 1, 2A, 2B,3A, 3B, 6A, 6B, 7, 8, and 9. For example, the nature and degree of thecurved distal portion 16 may be configured to match with the frontalsinus outflow tract or frontal recess.

Alternatively, the inner guide member 14 may have some degree ofmalleability such that the user may bend or impart some desired shape orconfiguration to the distal end of the inner guide member 14. Asexplained herein in more detail, the inner guide member 14 may includean optional lumen 18 (best illustrated in FIG. 5A) that extends thelength of the inner guide member 14. In particular, the inner guidemember 14 and the contained lumen 18 may extend from a distal end 20 toa proximal end 21 (best seen in FIGS. 2B and 3B) that interfaces with asealed arrangement with a port 22 disposed at a proximal end 24 of thehandle 12. The port 22 may be configured with a conventional interfacesuch as a Luer connector. The port 22 may be used as an aspiration portor a delivery port for fluids and/or medicaments, or for introduction ofa guide wire.

Still referring to FIG. 1, a shaft 30 is mounted about the periphery ofthe inner guide member 14. In particular, the shaft 30 is dimensioned toslide over the inner guide member 14 in response to actuation of anadvancer knob 32 located on the handle 12. The advancer knob 32 ismoveable along a slot 42 contained in a surface of the handle 12. Adistal end 34 of the shaft 30 includes a balloon 36 that is configuredto be selectively inflated or deflated as explained herein. During use,the inner guide member 14 is manipulated and advanced across or into theanatomical space of interest. The shaft 30 as well as the attachedballoon 36 is illustrated in a retracted state in FIG. 1. While FIG. 1illustrates the balloon 36 in an inflated state for better illustration,the balloon 36 is typically in a deflated state when the shaft 30 is inthe proximal position as illustrated in FIGS. 2A and 2B. After the innerguide member 14 is properly positioned, the user actuates the advancerknob 32 by sliding the same in the distal direction which, in turn,advances the shaft 30 and balloon 36 in a distal direction over thepre-placed inner guide member 14. Once the balloon 36 is properlyplaced, the balloon 36 is inflated. Inflation of the balloon 36 isaccomplished using an inflation device (not shown) that is coupled to aport 38 located at the proximal end 24 of the handle 12. One exemplaryinflation device that may be used in connection with the balloondilation catheter 10 is described in U.S. patent application Ser. No.12/372,691, which is incorporated by reference as if set forth fullyherein. Of course, other inflation devices may also be used. Aninflation lumen 48 contained within the shaft 30 (described in moredetail below), fluidically couples the port 38 to an interior portion ofthe balloon 36.

Still referring to FIG. 1, an optional support member 40 in the form ofa tube may be located about the external periphery of a portion of theshaft 30 to impart further stiffness to the balloon dilation catheter10. The particular length of the support member 40 may vary depending onthe application and may extend along some or all or the shaft 30. Thesupport member 40 may be made of a metallic material such as stainlesssteel hypotube that is secured to the shaft 30. The support member 40may be welded or bonded along a length of the shaft 30. Generally, thesupport member 40 does not cover the helical portion (described indetail below) of the shaft 30 that is contained within the handle 12.

FIGS. 2A and 2B illustrate, respectively, side and cross-sectional viewsof the balloon dilation catheter 10 with the advancer knob 32 and thusballoon 36 in the proximal position. In actual use, as explained herein,the balloon 36 is typically in a deflated state when the advancer knob32 is the proximal position as illustrated in FIGS. 2A and 2B. As bestseen in FIG. 1, the advancer knob 32 is slidably disposed along a lengthof the handle 12 inside a slot 42. The advancer knob 32 is thus able toslide back and forth in the distal/proximal direction along the lengthof the slot 42. The slot 42 may incorporate a stop or the like (notshown) to prevent the balloon 36 from being advance too far along thelength of the inner guide member 14. The length of the slot 42 may bevaried in different devices to adjust the length at which the balloon 36may be advanced. Generally, the slot 42 has a length within the range ofabout 1 inch to about 2 inches although other dimensions may fall withinthe scope of the invention.

As seen in FIG. 2B, the advancer knob 32 may be directly coupled to thesupport member 40 that is mounted on the shaft 30. Alternatively, theadvancer knob 32 may be coupled directly to the shaft 30. The advancerknob 32 may be configured or otherwise shaped to enable a finger of theuser (e.g., index finger or thumb) to easily advance or retract the knob32 along the slot 42 contained in the handle 12.

FIGS. 3A and 3B illustrate, respectively, side and cross-sectional viewsof the balloon dilation catheter 10 with the advancer knob 32 and thusballoon 36 in the distal position. Thus, unlike the configurations ofFIGS. 2A and 2B, the advancer knob 32 is located at or near the distalend 26 of the handle 12. Advancement of the advancer knob 32 also slidesthe shaft 30 and attached balloon 36 in a distal direction (arrow A inFIG. 3A) along the inner guide member 14. The balloon 36 thus ispositioned at or adjacent to the distal end 20 of the inner guide member14. The balloon dilation catheter 10 may be designed such that theadvancer knob 32 may be positioned at either the proximal or distalextremes as illustrated in FIGS. 2A, 2B, 3A, 3B.

Alternatively, the advancer knob 32 may be positioned somewhere inbetween the two extremes. For example, the optimal position of theballoon 36 may be accomplished by sliding the advancer knob 32 somefraction (e.g., ¾) of the full distance of the slot 42.

Referring to FIGS. 2B and 3B, the inner guide member 14 of the balloondilation catheter 10 extends from a distal end 20 to a proximal end 21that terminates in a sealed interface with a port 22 disposed at aproximal end 24 of the handle 12. The inner guide member 14 optionallyincludes a lumen 18 disposed therein that may be used to provideaspiration functionality via an aspiration device (not shown) coupled toport 22. Aspiration functionality permits the removal of blood and othersecretions. This makes it easier to visualize the placement of theballoon dilation catheter 10. The inner guide member 14 isadvantageously rigid to enable the balloon dilation catheter 10 to bepositioned without the need of a separate guiding catheter or guide wirein most, if not all, instances.

The inner guide member 14 may have a length of about 7 inches to about11 inches from the distal end 20 to the proximal end 21 when loaded intothe handle 12, although other dimensions may be used. The inner guidemember 14 may be formed from stainless steel hypotube having an innerdiameter in the range of about 0.020 inch to about 0.050 inch, and morepreferably between about 0.036 inch and 0.040 inch, with a wallthickness within the range of about 0.005 inch to about 0.020 inch, andmore preferably between about 0.008 inch to about 0.012 inch. The curveddistal portion 16 of the inner guide member 14 may be formed right tothe distal end 20 and may have a radius of curvature of about 0.25 inchto about 1.5 inch, and more preferably about 0.75 to about 1.25 inch.

The length of the inner guide member 14 that projects distally from thedistal-most portion of the balloon 36 is about 0.5 inch to about 2.0inch, and more preferably, about 0.8 inch to about 1.2 inch when theballoon 36 is in the fully retracted state (e.g., illustrated in FIGS.2A and 2B). As seen in FIGS. 1, 2A, 2B, 3A, 3B, 6A-6C, 7-11, the distalend 20 of the inner guide member 14 may incorporate an optional bulboustip 44 in order to make the distal end 20 more atraumatic. The bulboustip 44 further serves to limit forward movement of the balloon 36 andattached shaft 30 when they are advanced distally. The outer diameter ofthe tip 44 is preferably between about 1 mm and about 3 mm.

The balloon 36 is mounted on the shaft 30 so as to form a fluidic sealbetween the two components. The balloon 36 may be bonded to the shaftusing a weld, adhesive, or the like. Alternately, the balloon 36 may besecured to the shaft using a mechanical connection. Generally, anytechnique known to those skilled in the art may be used to secure to theballoon 36 to the shaft 30. Given that the balloon 36 is secureddirectly to the shaft 30, both structures are slidably mounted over theinner guide member 14. The balloon 36 generally takes on acylindrical-shape when inflated. While not limited to specificdimensions, the inflated balloon 36 has a diameter within the range ofabout 3 mm to about 9 mm, and more preferably a diameter within therange of about 5 to about 7 mm when inflated. The length of the balloon36 may generally fall within the range of about 10 mm to 25 mm althoughother lengths may be used. Both the shaft 30 and the balloon 36 arepreferably formed of high strength but flexible polymeric materials suchas polyamides (e.g., Nylon), PEBAX or the like. The balloon 36 may be“blow molded” to a relatively thin wall thickness, and capable ofholding relatively high pressures from about 6 atmospheres to about 20atmospheres of inflation pressure. The balloon 36 is inflated using afluid which is typically a liquid such as water or saline.

Referring now to FIG. 4, a magnified, cross-sectional view of a portionof the handle 12 is illustrated. At the proximal end 24 of the handle 12are located ports 22, 38. The port 22 may be configured with aconventional interface such as a Luer connector or any other connectorknown to those skilled in the art. The port 22 may be integrally formedwith the handle 12 or, alternatively, the port 22 may be a separatestructure that is secured to the handle 12 during assembly. As seen inFIG. 4, the proximal end 21 of the inner guide member 14 forms a sealingarrangement with the port 22. As explained herein, the port 22 may beused as an aspiration port or a delivery port for fluids and/ormedicaments.

FIG. 4 also illustrates port 38 which may be constructed in the same orsimilar manner as port 22 as described above. The port 38 is fluidicallycoupled to the inflation lumen 48 in the shaft 30. In this regard,inflation fluid from an inflation device (not shown) is able to passthrough the port 38 and into the inflation lumen 48 of the shaft 30. Theport 38 may be configured with a conventional interface such as a Luerconnector. The fluid then is able to travel along the length of theshaft 30 via the lumen 48 where the fluid enters the interior of theballoon 36. The inflation fluid is thus able to inflate the balloon 36upon actuation of the inflation device.

As best seen in FIG. 4, a portion of the handle 12 includes a recessedregion 50 that receives both the inner guide member 14 and the shaft 30.In the recessed region 50 of the handle 12, the shaft 30 is helicallywrapped around the outer periphery of the inner guide member 14 forminga helical portion 52. The helical portion 52 facilitates the distaladvancement and proximal retraction of the shaft 30 and attached balloon36 along the inner guide member 14 yet still maintains fluidcommunication with the port 38. The helical portion 52 of the shaft 30,which is located proximal to the advancer knob 32 is in the shape of ahelix that wraps around the inner guide member 14 and is configured toelongate and contract upon movement of the advancer knob 32. FIG. 4illustrates the state of the helical portion 52 after the advancer knob32 has been advanced distally. Thus, in the extended state, the lengthof the helical portion 52 traverses much if not all of the recessedregion 50. Contrast this with FIG. 2B which illustrates the helicalportion 52 compressed to the proximal portion of the recessed region 50because the advancer knob 32 is the in proximal position. Thus, thehelical portion 52 is thus able to expand or compress much in the waythat a spring does in response to a tensile or compressive load. One orboth of the inner guide member 14 and the helical portion 52 of theshaft 30 may be optionally coated or lined with a lubricious coating toprevent the contact surfaces from any unwanted frictional binding or thelike.

The helical portion 52 of the shaft 30 may be formed by “skiving” away aportion of the shaft 30. FIG. 5A illustrates a cross-sectional view ofthe shaft 30, inner support guide 14, and support member 40 along theline A-A′ of FIG. 2B. As seen in FIG. 2B, this area is distal to wherethe helical portion 52 of the shaft 30 is located. Referring now to FIG.5A, the shaft 30 includes a rider lumen 54 that is dimensioned to have adiameter that is slightly larger than the outer diameter of the innersupport guide 14. The rider lumen 54 thus enables the shaft 30 toadvance and retract over the inner support guide 14 in a close-fitarrangement. The outer diameter of the shaft 30 may generally fallwithin the range of about 0.050 inch to about 0.110 inch or within therange of about 0.070 inch to about 0.100 inch. One or both of theexterior surface of the inner guide member 14 and the interior surfaceof the rider lumen 54 may be optionally coated with a lubricious coatingto reduce frictional contact forces. FIG. 5B illustrates across-sectional view of the inner support guide 14 and the helicalportion 52 of the shaft 30 taken along the line B-B′ of FIG. 4. As seenin FIG. 5B, a portion of the shaft 30 that includes the rider lumen 54is skived away. The result is that a single lumen (inflation lumen 48)remains in the shaft 30 that is helically wrapped about the innersupport guide 14.

FIGS. 6A-6C illustrate various embodiments of an inner guide member 14.The inner guide member 14 may have a variety of shapes andconfigurations depending on the particular application or patient. Thedifferent shapes of the inner guide member 14 may be factory-formed in aparticular shape and offered as a different model as fully assembled or,alternatively, the inner guide member 14 may be replaceable or modularelements that could slide inside the rider lumen 54 and inserted intothe port 22 in a press-fit type sealing arrangement. In yet anotheralternative, the shapes could represent desirable shapes that amalleable inner guide member 14 could be formed into by the user tobetter fit a particular application or subject's anatomy.

FIG. 6A illustrates an inner guide member 14 that includes a curveddistal portion 16 that terminates in a straight segment 46. In theembodiment of FIG. 6A, the curve in the curved distal portion 16 ispronounced and turns back on itself in the shape of a “U” in which thedistal end 20 turns back in retrograde fashion. This embodiment may beuseful to treat hard to reach ostia or other structures, e.g., themaxillary ostium or the infundibulum via a transnasal route, if thenasal anatomy will allow for a transnasal approach. While FIG. 6Aillustrates a “U” shaped curve, other degrees of curvature arecontemplated. FIG. 6B illustrates an inner guide member 14 according toanother embodiment. In this embodiment, the curved distal portion 16also terminates in a straight segment 46 although the radius ofcurvature is less pronounced. In this embodiment, the straight segment46 may have a length within the range of about 8 mm to about 10 mmalthough other lengths may be used. It is believed that this embodimentis particularly suited for most frontal recess anatomy. FIG. 6Cillustrates an embodiment in which the inner guide member 14 issubstantially straight. This later embodiment may be particularly suitedfor treating the sphenoids of the subject, or straightforward frontalrecess anatomy.

FIG. 7 illustrates a balloon dilation catheter 10 according to anotherembodiment. In this embodiment, a tracking element 60 is located on thehandle 12 of the balloon dilation catheter 10. The tracking element 60may include an antenna, transmitter, optical reflectors, or the likethat communicates a wireless signal that is then received and processedto determine the orientation and/or positioning of the balloon dilationcatheter 10. In certain embodiments, more than one tracking element 60may be disposed on the balloon dilation catheter 10. Data regarding theorientation and/or positioning of the balloon dilation catheter 10 maythen be processed and displayed on the display for viewing by thephysician. For example, image guided surgery is becoming increasinglycommonplace, permitting physicians to review real time actual or virtualimages of a particular device within a subject during a surgicalprocedure.

For example, U.S. Pat. Nos. 5,391,199 and 5,443,489, which areincorporated by reference, describe a system wherein coordinates of anintrabody probe are determined using one or more field sensors such as,Hall effect devices, coils, or antennas that are carried on the probe.U.S. Patent Application Publication No. 2002-0065455, which is alsoincorporated by reference, describes a system that is capable ofgenerating a six-dimensional position and orientation representation ofthe tip of a catheter using a combination of sensor and radiation coils.U.S. Patent Application Publication No. 2008-0269596, which is alsoincorporated by reference, describes yet another monitoring system thathas particular applications in orthopedic procedures. Commercial systemssuch as the LANDMARX Element (Medtronic Xomed Products, Inc.,Jacksonville, Fla.) are available for use in conjunction with ENTprocedures.

In the embodiment of FIG. 7, the tracking element 60 permits accuratetracking of the distal end 20 of the balloon dilation catheter 10 suchthat an image of distal portion of the balloon dilation catheter 10 maybe superimposed on a patient's anatomical imagery. For example, apreviously conducted computed tomography (CT) scan of the patient may beused to generate a visual image of the patient's anatomical regions ofinterest. Based on the location of the tracking element 60, an imageguided surgery (IGS) system can then superimpose an image of the balloondilation catheter 10 onto the image to better enable the physician tomanipulate and orient the balloon dilation catheter 10.

Other commercial systems may also be used in connection with the balloondilation catheter 10 illustrated in FIG. 7. For example, the INSTATRAK3500 Plus—ENT from GE Healthcare, Chalfont St. Giles, United Kingdom maybe integrated and/or used with the balloon dilation catheter 10. The useof CT guidance to position the balloon dilation catheter 10 is preferredbecause the device may be positioned by the operator with just a singlehand, while viewing the CT image interface (e.g., display) at the sametime the handle 12 is manipulated. Optionally, the balloon dilationcatheter 10 may be initially positioned using and endoscope or othervisualization tool. For instance, a conventional “Hopkins rod” endoscope(not shown) may be manipulated alongside the balloon dilation catheter10 to aid in placement.

FIGS. 8-12 illustrate various cross-sectional views (sagittal plane) ofthe frontal sinus of a subject undergoing treatment with a balloondilation catheter 10. The cross-sectional views illustrate the nasalpassageway 100, the frontal recess 102, and the frontal sinus cavity104. Referring to FIG. 8, the balloon dilation catheter 10 is insertedinto the nasal passageway 100 with the advancer knob 32 in the retractedposition (e.g., as illustrated in FIG. 1, 2A, 2B) such that the shaft 30and balloon 36 are also retracted proximally. In addition, the balloon36 is in a deflated state as seen in FIG. 8. The curved portion 16 ofthe inner guide member 14 is then positioned within the frontal recess102 of the subject as seen in FIG. 8. This positioning of the innerguide member 14 may be accomplished under endoscopic visualization usinga conventional endoscope such as a Hopkins rod-type endoscope that ispositioned alongside the balloon dilation catheter 10. Alternatively,the inner guide member 14 may be positioned using IGS techniques thattrack the position of the balloon dilation catheter 10 using one or moretracking elements 60 as illustrated, for instance, in the embodiment ofFIG. 7. For instance, the inner guide member 14 may be advanced underguidance from CT imaging.

Referring now to FIG. 9, confirmation of accurate positioning of theinner guide member 14 within the frontal recess 102 may be accomplishedby placement of a fluoroscopically visible guide wire 64 through thelumen 18 of the inner guide member 14. The guide wire 64 may be insertedinto the lumen 18 via the port 22. Under fluoroscopic visualization, theguide wire 64 can be seen to advance into the frontal sinus cavity 104once the inner guide member 14 is positioned properly within the frontalrecess 102. If the guide wire 64 does not advance into the frontal sinuscavity 104, the balloon dilation catheter 10 is re-positioned andconfirmation is subsequently attempted. As an alternative to afluoroscopically visible guide wire 64, the guide wire 64 could be alight emitting guide wire such as that disclosed in U.S. PatentApplication Publication No. 2007-0249896, which is incorporated byreference herein. Of course, the guide wire 64 is optional as the innerguide member 14 may be placed without the aid or need for the same.Alternatively, the guide wire 64 could be positioned in the frontalsinus initially, prior to placement of the balloon catheter 10.

Now referring to FIG. 10, once the curved portion 16 of the inner guidemember 14 is properly positioned, the advancer knob 32 is advanced inthe distal direction (arrow A of FIG. 3A) thereby advancing the shaft 30and attached balloon 36 into the frontal recess 102. This is illustratedin FIG. 10. After the balloon 36 is positioned in the frontal recess102, the balloon 36 is inflated as illustrated in FIG. 11. Inflation isaccomplished by coupling an inflation device (not shown) to the port 38.The inflation device may include a syringe or the like that is depressedto infuse a fluid into the inflation lumen 48 which then passes into theinterior of the balloon 36 to effectuate expansion of the balloon 36 tothe state illustrated in FIG. 11. Pressures typically used to accomplishwidening or remodeling of the frontal recess 102 are within the range ofabout 3 atmospheres to about 12 atmospheres. The balloon 36 may beinflated only a single time or, alternatively, the balloon 36 may beinflated, deflated, and inflated again a plurality of times in order toachieve the desired degree of widening. Each inflation step may beperformed after positioning the balloon 36 in a different positionwithin the frontal recess 102.

After the frontal recess 102 has been widened or otherwise remodeled,the balloon 36 is deflated and removed as illustrated in FIG. 12. Thewidened frontal recess 102 illustrated in FIG. 12 is believed to restorethe drainage and aeration function and health of the frontal sinuscavity 104. Deflation of the balloon 36 is accomplished by reducing thefluid pressure within the interior of the balloon 36. For example, theplunger of a syringe or the like that is fluidically coupled to the port38 may be withdrawn to remove fluid from the interior of the balloon 36.The balloon dilation catheter 10 can then be withdrawn proximally fromthe nasal passageway 100.

In certain patients, treatment of one or both frontal sinuses 104 asdescribed above may be adequate. In other patients, additional sinusesmay need to be treated, particularly the maxillary and/or anteriorethmoid sinuses. In such patients, a combination procedure may be wellsuited. The maxillary and/or anterior ethmoid sinuses can be treatedwith a system such as described in U.S. Pat. No. 7,520,876 and U.S.Patent Application Publication No. 2008-0172033, commercially availableas the FinESS system by Entellus Medical, Inc. of Maple Grove, Minn.Alternatively, other sinuses could be treated more conventionally usingsurgical techniques such as, for instance, functional endoscopic sinussurgery (FESS).

Also, the sphenoid and/or maxillary sinus outflow tracts could bedilated with the embodiment of the balloon catheter 10 described above.It is also contemplated that the balloon catheter 10, particularly theembodiment of FIG. 7 with a suitable IGS device is incorporated, andwith an appropriate shape for the inner support member 14, preferablystraight as illustrated in FIG. 6C, could be used to dilate themaxillary sinus outflow tract via the canine fossa route. Suitableaccess tools are described in co-pending U.S. patent application Ser.No. 12/038,719, which is incorporated by reference herein. This could beperformed without need for additional endoscopic visualization,permitting treatment through a relatively small diameter accesspassageway into the sinus cavity in the region of the canine fossa. Asmall endoscope (not shown) could be utilized, if desired, through thelumen 18 of the inner support member 14 to further aid in visualizationof the maxillary sinus outflow tract.

While embodiments of the present invention have been shown anddescribed, various modifications may be made without departing from thescope of the present invention. The invention, therefore, should not belimited, except to the following claims, and their equivalents.

What is claimed is:
 1. A method of treating an outflow tract that opensinto a nasal passage of a subject using a balloon dilation catheter, themethod comprising: providing a balloon dilation catheter that includes ahandle defining a slot extending along a longitudinal exterior surfaceof the handle, a substantially rigid inner guide member extendinglongitudinally from the handle, a movable shaft coupled to a balloon andslidably mounted on the substantially rigid inner guide member, and aballoon advancement member slidably disposed within the slot andconfigured to advance the shaft and the balloon in a distal directionover the substantially rigid inner guide member; advancing thesubstantially rigid inner guide member into the outflow tract of thesubject via the nasal passageway; advancing the balloon advancementmember in the distal direction while keeping the handle static relativeto the outflow tract, wherein advancing the balloon advancement memberplaces the balloon at a desired location in the outflow tract; andinflating the balloon.
 2. The method of claim 1, wherein the shape ofthe substantially rigid inner guide member is adjusted prior toadvancement to the desired location.
 3. The method of claim 2, whereinthe shape is adjusted by replacing a substantially rigid inner guidemember having a first shape with a substantially rigid inner guidemember having a second shape.
 4. The method of claim 2, wherein theshape is adjusted by manually bending the substantially rigid innerguide member.
 5. The method of claim 1, wherein the substantially rigidinner guide member includes a lumen, the lumen being coupled to anaspiration source configured to aspirate the outflow tract.
 6. Themethod of claim 1, wherein, prior to inflation of the balloon, thesubstantially rigid inner guide member includes a lumen and a guide wireis inserted into the lumen and advanced until a distal portion extendsfrom a distal end of the substantially rigid inner guide member.
 7. Themethod of claim 6, further comprising re-positioning the substantiallyrigid inner guide member based at least in part on the location of thedistal portion of the guide wire.
 8. The method of claim 1, wherein thehandle comprises a distal stop configured to prevent continued distaladvancement of the balloon.
 9. The method of claim 1, wherein the handlecomprises an inflation port that is attached to a proximal end of thehandle.
 10. The method of claim 9, wherein the balloon advancementmember is advanced from a first proximal position to a second distalposition and wherein the first proximal position and the second distalposition are both distal with respect to the inflation port.
 11. Themethod of claim 1, wherein the balloon is inflated to a pressure withinthe range of about 3 atmospheres to about 12 atmospheres.
 12. The methodof claim 1, wherein the balloon is inflated, deflated, and inflated aplurality of times.
 13. The method of claim 1, wherein the outflow tractis an outflow tract of a sinus cavity.
 14. The method of claim 13,wherein the sinus cavity is a sphenoid sinus cavity.
 15. The method ofclaim 13, wherein the sinus cavity is a maxillary sinus cavity.
 16. Themethod of claim 13, wherein the sinus cavity is a frontal sinus cavity.17. The method of claim 1, further comprising tracking the movement ofthe substantially rigid inner guide member into the outflow tract usingan image guided surgery system.
 18. The method of claim 17, wherein theimage guided surgery system comprises a CT guidance system.